使用多种支气管镜引导技术诊断孤立性肺结节:一项前瞻性随机研究

背景

计算机X线摄影(CR)的肺结节检出率约为0.09-0.2%,因此快速鉴别具有恶性可能性的孤立性肺结节(SPN)的性质是肺癌早期诊断的关键挑战。

目的

我们进行了这项研究,以比较支气管超声检查与引导鞘(EBUS-GS)的诊断率和安全性,以及EBUS-GS和虚拟支气管镜导航(VBN)的组合。

方法

这是一项前瞻性,多中心,多臂,随机对照试验,共涉及1010名受试者。所有招募的患者都进行了胸部CT扫描,发现需要诊断的SPN。受试者随机分为三组:传统,非指导,支气管镜检查活检组(NGB组),EBUS-GS引导支气管镜活检组(EBUS组)和联合EBUS-GS的引导下支气管镜活组织检查组与VBN(组合组)。主要终点是调查三组诊断产量之间的差异。

结果

EBUS组(72.3%)和联合组(74.3%)的诊断率无显着差异,但NGB组的诊断率为41.2%。达到活检位置所需的时间在联合组中显着较少(联合组为7.96±1.18分钟,而EBUS组为11.92±5.37分钟,p <0.05)。然而,EBUS-GS和联合组的支气管镜手术时间相同。直径> 20 mm的外周肺部病变(PPL)的诊断率明显高于直径<20 mm的患者。

结论

我们的研究结果表明,引导支气管镜检查可以提高周围病变的诊断率。EBUS与联合组之间的诊断率无显着差异,但EBUS-GS与VBN的使用可显着缩短支气管镜的到达时间。

Background

The rate of detection of pulmonary nodules on computed radiography (CR) is approximately 0.09–0.2%, so rapid identification of the nature of solitary pulmonary nodules (SPNs) with a likelihood of malignancy is a critical challenge in the early diagnosis of lung cancer.

Objective

We conducted this study to compare the diagnostic yield and safety of endobronchial ultrasonography with a guide sheath (EBUS-GS), and the combination of EBUS-GS and virtual bronchoscopic navigation (VBN).

Methods

This was a prospective, multicenter, multi-arm, randomized controlled trial involving a total of 1010 subjects. All the patients recruited underwent a chest CT scan which found SPNs that needed to be diagnosed. The subjects were randomly divided into one of three groups: a traditional, non-guided, bronchoscopy biopsy group (NGB group), an EBUS-GS guided bronchoscopy biopsy group (EBUS group), and a guided bronchoscopy biopsy group that combined EBUS-GS with VBN (combined group). The primary endpoint was to investigate the differences between the diagnostic yields of the three groups.

Results

There was no significant difference in the diagnostic yield between the EBUS group (72.3%) and the combined group (74.3%), but the diagnostic yield for the NGB group was 41.2%. The time required to reach biopsy position was significantly less in the combined group (7.96 ± 1.18 min in the combined group versus 11.92 ± 5.37 min in the EBUS group, p < 0.05). However, the bronchoscope operation time was the same in the EBUS-GS and combined groups. The diagnostic yield for peripheral pulmonary lesions (PPLs) >20 mm in diameter was significantly higher than for those <20 mm in diameter.

Conclusion

The results of our study suggest that guided bronchoscopy could increase the diagnostic yield in the context of peripheral lesions. There was no significant difference in the diagnostic yield between the EBUS and combined groups, but use of EBUS-GS with VBN could significantly shorten the bronchoscope arrival time.

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